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Relationships between apparent diffusion coefficient (ADC) histogram analysis parameters and PD-L 1-expression in head and neck squamous cell carcinomas: a preliminary study

Hans-Jonas Meyer
Hans-Jonas Meyer
, 
Anne Kathrin Höhn
Anne Kathrin Höhn
 et 
Alexey Surov
Alexey Surov
   | 20 janv. 2021
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Article Category: Research Article
Publié en ligne: 20 janv. 2021
Pages: 150 - 157
Reçu: 22 oct. 2020
Accepté: 13 déc. 2020
DOI: https://doi.org/10.2478/raon-2021-0005
© 2021 Hans-Jonas Meyer, Anne Kathrin Höhn, Alexey Surov, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Figure 1

Representative case with a negative programmed cell death ligand 1 (PD-L1) score. (A) Postcontrast T1-weighted image shows a large enhancing tumor of the right tongue base (arrow). A large lymph node metastasis on the right side can also be appreciated. (B) Apparent diffusion coefficient (ADC) map of the same slide. Both lesions show a marked hypointensity consistent with a diffusion restriction. The tumor (arrow) is surrounded with a region of interest, which is drawn on every tumor showing slide within the margins of the tumor in accordance to the corresponding T1-weighted images. (C) The resulting ADC histogram of the tumor. The histogram analysis parameters (× 10-3 mm2/s) are as follows: ADCmin = 0.79, ADCmean = 1.38, ADCmax = 2.05, P10 = 1.05, P25 = 1.19, P75 = 1.53, P90 = 1.78, median = 1.35,mode = 1.27, kurtosis = 2.61, skewness = 0.41 and entropy = 2.44. (D) The corresponding PD-L1 stained specimen. No staining can be appreciated resulting in a value of 0 in all calculated scores.
Representative case with a negative programmed cell death ligand 1 (PD-L1) score. (A) Postcontrast T1-weighted image shows a large enhancing tumor of the right tongue base (arrow). A large lymph node metastasis on the right side can also be appreciated. (B) Apparent diffusion coefficient (ADC) map of the same slide. Both lesions show a marked hypointensity consistent with a diffusion restriction. The tumor (arrow) is surrounded with a region of interest, which is drawn on every tumor showing slide within the margins of the tumor in accordance to the corresponding T1-weighted images. (C) The resulting ADC histogram of the tumor. The histogram analysis parameters (× 10-3 mm2/s) are as follows: ADCmin = 0.79, ADCmean = 1.38, ADCmax = 2.05, P10 = 1.05, P25 = 1.19, P75 = 1.53, P90 = 1.78, median = 1.35,mode = 1.27, kurtosis = 2.61, skewness = 0.41 and entropy = 2.44. (D) The corresponding PD-L1 stained specimen. No staining can be appreciated resulting in a value of 0 in all calculated scores.

Figure 2

Representative case with a positive programmed cell death ligand 1 (PD-L1) score. (A) On the postcontrast T1-weighted image a large enhancing tumor of the side within the right palatine tonsil (arrow). Susceptibility artifacts due to dental material can also be appreciated. (B) Apparent diffusion coefficient (ADC) map on the corresponding slide. A marked hypointensity can be seen consistent with a diffusion restriction. (C) The resulting ADC histogram of the tumor. The histogram analysis parameters (× 10-3 mm2/s) are as follows: ADCmin = 0.51, ADCmean = 0.78, ADCmax = 1.36, P10 = 0.63, P25 = 0.69, P75 = 0.87, P90 = 0.94, median = 0.76, mode = 0.69, kurtosis = 4.57, skewness = 0.72, and entropy = 2.41. (D) The corresponding PD-L1 stained specimen. A weak staining of PD-L1 for tumor cells and associating immune cells can be appreciated. The resulting score values are 5 for the combined positive score and 3 for the immune cell score.
Representative case with a positive programmed cell death ligand 1 (PD-L1) score. (A) On the postcontrast T1-weighted image a large enhancing tumor of the side within the right palatine tonsil (arrow). Susceptibility artifacts due to dental material can also be appreciated. (B) Apparent diffusion coefficient (ADC) map on the corresponding slide. A marked hypointensity can be seen consistent with a diffusion restriction. (C) The resulting ADC histogram of the tumor. The histogram analysis parameters (× 10-3 mm2/s) are as follows: ADCmin = 0.51, ADCmean = 0.78, ADCmax = 1.36, P10 = 0.63, P25 = 0.69, P75 = 0.87, P90 = 0.94, median = 0.76, mode = 0.69, kurtosis = 4.57, skewness = 0.72, and entropy = 2.41. (D) The corresponding PD-L1 stained specimen. A weak staining of PD-L1 for tumor cells and associating immune cells can be appreciated. The resulting score values are 5 for the combined positive score and 3 for the immune cell score.

Figure 3

Correlation analysis between skewness derived from apparent diffusion coefficient (ADC) and the immune cell score (ICS). The resulting Spearman’s correlation coefficient is r = -0.38, p = 0.04.
Correlation analysis between skewness derived from apparent diffusion coefficient (ADC) and the immune cell score (ICS). The resulting Spearman’s correlation coefficient is r = -0.38, p = 0.04.

Overview of the included patients

Localizationn (%)
          Tonsil7 (24.1)
          Tongue7 (24.1)
          Hypopharynx6 (20.7)
          Oropharynx5 (17.2)
          Larynx4 (13.9)
Grading
          Moderate (G2)12 (37.5)
          Poor (G3)17 (62.5)
Stage
          T26 (20.7)
          T310 (34.5)
          T413 (44.8)
Nodal status
          Nodal positive25 (86.2)
          Nodal negative4 (13.8)

Overview of the investigated apparent diffusion coefficient (ADC) histogram parameters

ParameterMean ± standard deviation, x10-3 mm2/sRange, x10-3 mm2/s
Mean1.14 ± 0.220.78-1.68
Min0.70 ± 0.250.17-1.24
Max1.78 ± 0.321.35-2.39
P100.90 ± 0.210.54-1.41
P251.0 ± 0.210.64-1.50
P751.27 ± 0.240.87-1.82
P901.41 ± 0.260.94-2.03
Median1.12 ± 0.220.76-1.64
Mode0.97 ± 0.280.78-1.55
Kurtosis3.74 ± 1.402.23-7.93
Skewness0.49 ± 0.49-0.54-1.49
Entropy2.44 ± 0.491.67-3.75
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Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology
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